GRAND LAKE MENTAL HEALTH CENTER INC (NPI# 1588074595) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588074595 |
| Entity Type | Organization |
| Organization Name | GRAND LAKE MENTAL HEALTH CENTER INC |
| Other Organization Name | GRAND LAKE MEDICAL HEALTH CENTER |
| Practice Address |
111 S Treaty Rd Miami OK 74354-5327 |
| Mailing Address |
114 W Delaware Ave Nowata OK 74048-2601 |
| Practice Telephone | 9185401511 |
| Mailing Telephone | 9182731841 |
| Mailing Fax Number | 9182731843 |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2020-07-31 |
| Authorized Official Name | MR. LARRY SMITH (CEO) |
| Authorized Official Telephone | 9182731841 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Grand Lake Medical Health Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659904076 | Grand Lake Mental Health Center Inc | Clinic/Center | 4815 S Harvard Ave Ste 420, Tulsa, OK 74135-3068 | 2020-02-13 |
| 1356981138 | Grand Lake Mental Health Center Inc | Community/Behavioral Health | 2225 N Union, Ponca City, OK 74601-1536 | 2020-01-09 |
| 1588136758 | Grand Lake Mental Health Center Inc | Clinic/Center | 4815 S. Harvard, Suite 420, Tulsa, OK 74135-3068 | 2018-12-27 |
| 1295145217 | Grand Lake Mental Health Center Inc | Clinic/Center | 1115 S Harber Rd, Grove, OK 74344-7918 | 2014-04-29 |
| 1043842370 | Grand Lake Mental Health Center Inc | Clinic/Center | 2225 N Union St., Ponca City, OK 74601-7460 | 2020-02-05 |
| 1689206922 | Grand Lake Mental Health Center Inc | Clinic/Center | 1015 W Washbourne St, Jay, OK 74346-4205 | 2020-02-05 |
| 1992341671 | Grand Lake Mental Health Center Inc | Clinic/Center | 1624 Cimarron Plz, Stillwater, OK 74075-3467 | 2019-11-18 |
| 1457993834 | Grand Lake Mental Health Center Inc | Clinic/Center | 124 E 6th St, Pawhuska, OK 74056-4204 | 2019-10-17 |
| 1134539141 | Grand Lake Mental Health Center Inc | Clinic/Center | 12005 E 470 Rd, Claremore, OK 74017-3737 | 2014-04-29 |
| Street Address |
111 S TREATY RD |
| City | MIAMI |
| State | OK |
| Zip Code | 74354-5327 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356333819 | Julie D Finney | Physician Assistant | 111 S Treaty Rd, Miami, OK 74354-5327 | 2005-08-19 |
| 1194336156 | Presley Ashtin Goff | Social Worker | 111 S Treaty Rd, Miami, OK 74354-5327 | 2020-08-13 |
| 1649898529 | Caressa Russell | Social Worker | 111 S Treaty Rd, Miami, OK 74354-5327 | 2020-07-08 |
| 1043838899 | Brandon Allan Maples | Peer Specialist | 111 S Treaty Rd, Miami, OK 74354-5327 | 2020-07-08 |
| 1942823190 | Zaine Alexander Gibson | Behavioral Analyst | 111 S Treaty Rd, Miami, OK 74354-5327 | 2020-05-22 |
| 1215558127 | Sydnee Marie Vance | Case Manager/Care Coordinator | 111 S Treaty Rd, Miami, OK 74354-5327 | 2020-05-01 |
| 1558981217 | Michael Shane Allen | Case Manager/Care Coordinator | 111 S Treaty Rd, Miami, OK 74354-5327 | 2020-04-23 |
| 1093335754 | Jonathan Kyle Shinn | Counselor | 111 S Treaty Rd, Miami, OK 74354-5327 | 2020-04-23 |
| 1972139475 | Lila Renee Metzker | Counselor | 111 S Treaty Rd, Miami, OK 74354-5327 | 2020-03-16 |
| 1518591254 | Amanda Wren | Case Manager/Care Coordinator | 111 S Treaty Rd, Miami, OK 74354-5327 | 2020-03-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447786603 | Coal Creek Counseling, LLC | Social Worker | 204 D St Ne, Miami, OK 74354 | 2017-05-10 |
| 1164958567 | Yco Tulsa, Inc | Counselor | 1458 E Steve Owens Blvd, Miami, OK 74354 | 2017-05-04 |
| 1982064226 | Yco Tulsa, Inc | Clinic/Center | 1519 E Steve Owens Blvd, Miami, OK 74354 | 2016-02-29 |
| 1548641285 | Courtney Marie Winfrey | Occupational Therapy Assistant | 310 2nd Ave Sw Fl 3, Miami, OK 74354 | 2015-06-17 |
| 1417338039 | Michelle Dawn Johnson | Case Manager/Care Coordinator | 1519 E. Steve Owens Blvd, Miami, OK 74354 | 2015-06-10 |
| 1790100337 | Jordan Taylor-threet | Speech-Language Pathologist | 2225 N. Main St., Miami, OK 74354 | 2014-02-19 |
| 1700137551 | Miami Healthcare, LLC | Skilled Nursing Facility | 2530 North Elm St., Miami, OK 74354 | 2012-09-19 |
| 1144507534 | Julia Brown | Pharmacist | 11 West Central, Miami, OK 74354 | 2011-11-14 |
| 1841504685 | Dodie A Giles Keith | Counselor | 33 C Street Northeast, Miami, OK 74354 | 2010-08-04 |
| 1013221571 | Katherine Renee Burke | Counselor | 111 S. Treaty Rd., Miami, OK 74354 | 2010-07-27 |
| Find all providers in zip 74354 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
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|---|---|---|---|---|
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| 1053912469 | Loves Community Mental Health Inc | Clinic/Center | 2 Nw 30th Ave, Miami, FL 33125 | 2020-11-03 |
| 1437759032 | Loves Community Mental Health Inc | Clinic/Center | 3011 W Flagler St Unit A, Miami, FL 33135-1222 | 2020-11-01 |
| 1831799766 | Mindset Mental Health Services Inc | Clinic/Center | 12485 Sw 137th Ave Ste 109, Miami, FL 33186-4215 | 2020-10-29 |
| 1669089892 | Dayspring Treatment Center LLC | Clinic/Center | 240 Nw 183rd St, Miami, FL 33169-4462 | 2020-10-01 |
| 1790392892 | Salutem Medical Group, LLC | Clinic/Center | 13701 Sw 88th St Ste 306a, Miami, FL 33186-1309 | 2020-09-23 |
| 1861007346 | Deluxe Life Medical Group Corp | Clinic/Center | 4017 Sw 152nd Ave, Miami, FL 33185-5919 | 2020-09-11 |
| 1013522945 | Max Community Wellness Center Inc | Clinic/Center | 10300 Sunset Dr Ste 164, Miami, FL 33173-3002 | 2020-09-08 |
| 1275147936 | Heaven Community Mental Health, LLC | Clinic/Center | 9254 Sw 40th St, Miami, FL 33165-4151 | 2020-09-01 |
| 1861002362 | E & P Behavior Services LLC | Clinic/Center | 12039 Sw 132nd Ct Unit 4-5, Miami, FL 33186-4783 | 2020-08-09 |
| Find all providers in MIAMI | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.